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Millicent Platt v. Fireman's Fund Insurance Company

May 22, 2012

MILLICENT PLATT, PLAINTIFF,
v.
FIREMAN'S FUND INSURANCE COMPANY,
DEFENDANT.



The opinion of the court was delivered by: Buckwalter, S.J.

MEMORANDUM

Currently pending before the Court is the Motion for Partial Summary Judgment filed by Defendant Fireman's Fund Insurance Company. For the following reasons, the Motion is granted in part and denied in part as set forth in the accompanying Order.

I. INTRODUCTION

On December 23, 2008, Plaintiff Millicent Platt was struck by a vehicle driven by Dr. Richard Ellis, who was insured by Defendant Fireman's Fund Insurance Company. (Def.'s Mot. Summ. J., Ex. A-1, Dep. of Millicent Platt ("Platt Dep."), 12:12-15, Feb. 9, 2012; Pl.'s Resp. Opp'n, Ex. D, Fireman's Fund Claim History Caption Report ("Claim Report") at FFIC 00091-92.) As a result of the accident, Plaintiff sustained several injuries, including a fractured tibia and a partial tear of a ligament in her left leg. (Claim Report at FFIC 00090.) She was also unable to return to her job as an underwriting assistant at the Philadelphia Insurance Company. (Platt Dep. 10:6-14, 12:6-11.)

On December 24, 2008, Defendant opened a third-party bodily injury file in connection with Plaintiff's claim against Dr. Ellis. (Claim Report at FFIC 00092.) Subsequently, on February 16, 2010, Defendant also opened a claim under the First Party Benefits endorsement of Dr. Ellis's insurance policy. (Id. at FFIC 00086.) These benefits are referred to as Personal Injury Protection ("PIP"). (Pl.'s Resp. Opp'n, Ex. G, Dep. of Julie Franklin ("Franklin Dep."), 13:13-20, Feb. 29, 2012.) PIP provides a maximum amount of $177,500 for first party benefits coverage, and includes medical benefits and wage loss. (Def.'s Mot. Partial Summ. J., Ex. B-1, Automobile Insurance Policy Issued to Dr. Richard A. Ellis ("Policy") at FFIC 00006.) After receiving Plaintiff's PIP Application and Affidavit of No Insurance on March 23, 2010, Defendant began to process Plaintiff's medical benefits, ultimately paying out $53,521.73. (Def.'s Mot. Summ. J., Ex. B, Decl. of Amy Brott ("Brott Decl.") ¶¶ 10-12.)

Plaintiff also sought wage loss benefits under the PIP policy, which required her to submit to Defendant wage verification from her employer as well as medical proof of her disability. (Id. ¶¶ 13-15.) After reviewing two medical reports, Defendant "determined that while [Plaintiff] was disabled for certain periods of time after the accident and her various surgeries, she was able to work a sedentary job at other times, so long as she was able to commute to work without having to walk any significant distance." (Id. ¶ 18.) In accordance with these findings, Defendant issued a $34,581.02 check to Plaintiff on June 1, 2011. (Id. ¶ 19.) Defendant admits that when calculating the wage loss, it mistakenly excluded the time Plaintiff received short term disability benefits, which resulted in an improper deduction of $3,716.66 from the payment. (Id. ¶ 20.) Plaintiff disagreed with the amount Defendant paid her, and returned the check after marking it "VOID." (Id. ¶ 22.)

On August 24, 2011, Defendant received a supplemental report that stated Plaintiff was unable to do even sedentary work. (Id. ¶¶ 23-24.) Based on this new information, Defendant determined that Plaintiff was unable to work from the date of the accident onward. (Id. ¶ 25.) Accordingly, on September 19, 2011, Defendant issued Plaintiff a check in the amount of $113,438.70, and made regular monthly wage payments until the entire $177,500 limit of the PIP policy was exhausted on December 20, 2011. (Id. ¶¶ 26-27.)

On May 25, 2011, Plaintiff filed her Complaint in the Philadelphia Court of Common Pleas. The Complaint alleged that Defendant breached the insurance contract by: (1) not paying Plaintiff in accordance with the terms of the policy and with 75 Pa. C.S. § 1712 et seq.; (2) failing to timely investigate and make payment in the absence of an investigation; (3) failing to exercise good faith and breaching fiduciary duties; and (4) failing to reimburse Plaintiff for expenses she incurred in connection with her medical care, including transportation costs. (Compl. ¶¶ 28-31.) The Complaint further alleged that Defendant acted in bad faith by: (1) failing to act promptly on Plaintiff and her counsel's communications; (2) failing to implement reasonable standards for prompt investigations of claims; (3) refusing to pay Plaintiff's claims without conducting a reasonable investigation; (4) failing to effectuate a prompt and equitable settlement of Plaintiff's claims; (5) failing to provide a reasonable explanation for refusing to pay money owed to Plaintiff; (6) misrepresenting pertinent facts related to insurance coverage; (7) failing to act promptly upon receipt of communications related to Plaintiff's claims; and (8) failing to provide a reasonable explanation for denying Plaintiff's claims. (Id. ¶ 38.) Plaintiff sought compensatory damages, as well as attorney's fees, costs, and punitive damages pursuant to 42 Pa. C.S. § 8371.

Defendant successfully removed the action to this Court on June 22, 2011, and filed the present Motion for Partial Summary Judgment on March 23, 2012.*fn1 Plaintiff filed her Response in Opposition on April 6, 2012, and Defendant filed a Reply Brief on April 13, 2012, making the Motion ripe for disposition.

II. STANDARD OF REVIEW

Summary judgment is proper "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). A factual dispute is "material" only if it might affect the outcome of the case. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). For an issue to be "genuine," a reasonable fact-finder must be able to return a verdict in favor of the non-moving party. Id.

On summary judgment, it is not the court's role to weigh the disputed evidence and decide which is more probative, or to make credibility determinations. Boyle v. Cnty. of Allegheny, Pa., 139 F.3d 386, 393 (3d Cir. 1998) (citing Petruzzi's IGA Supermarkets, Inc. v. Darling-Delaware Co., Inc., 998 F.2d 1224, 1230 (3d Cir. 1993)). Rather, the court must consider the evidence, and all reasonable inferences which may be drawn from it, in the light most favorable to the non-moving party. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587-88 (1986) (citing U.S. v. Diebold, Inc., 369 U.S. 654, 655 (1962)); Tigg Corp. v. Dow Corning Corp., 822 F.2d 358, 361 (3d Cir. 1987). If a conflict arises between the evidence presented by both sides, the court must accept as true the allegations of the non-moving party, and "all justifiable inferences are to be drawn in his favor." Anderson, 477 U.S. at 255.

Although the moving party bears the initial burden of showing an absence of a genuine issue of material fact, it need not "support its motion with affidavits or other similar materials negating the opponent's claim." Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). It can meet its burden by "pointing out . . . that there is an absence of evidence to support the nonmoving party's case." Id. at 325. Once the movant has carried its initial burden, the opposing party "must do more than simply show that there is some metaphysical doubt as to material facts." Matsushita Elec., 475 U.S. at 586. "[T]here is no issue for trial unless there is sufficient evidence favoring the nonmoving party for a jury to return a verdict for that party." Anderson, 477 U.S. at 249. Summary judgment may be granted when "the evidence is merely colorable . . . or is not significantly probative." Id. at 249-50 (citations omitted).

III. DISCUSSION

Defendant moves for summary judgment on Plaintiff's bad faith and breach of contract claims, as well as her request for attorney's fees. ...


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